How to Grow Fast and Cope with Fast Growth?

(Robin Dickinson) #1

@lizfischer and I started to have a conversation privately that I wanted to make public. I’d like to get some different perspectives on growing fast.

I personally wanted to grow slowly. I had an infant and a toddler, personal medical crises, etc. So even though I was the only income for my family, I had to pace myself or I wouldn’t have been able to manage. But I know for a lot of other people that’s not a reasonable pace.

I asked @lizfischer to share how they were able to grow relatively quickly (she said they did things both intentionally and unintentionally) and also how they coped with so many new patients at once? I know that those who do grow quickly often feel like they are drowning in success.

I’d love to hear from others who have grown quickly. Or from those who have grown slowly if there’s anything you think newbies could learn from what you did or didn’t do in order to grow at their chosen pace?

(Jason Larsen) #2

Great topic!

Fast vs. slow growth is probably a bit relative amongst us all.

We grew slower than we wanted, but also didn’t want to grow quickly because we wanted to be able to correct course quickly with less risk involved.

For context: (we thought this was slow, but my job as CEO / manager was to build things ‘faster than normal’) our basic growth pattern was… within the first 3 months we had around 250-300 members. After that initial surge, we grew at a rate of about 20-25 patients per month through the 3rd year, and just recently (year #4), we have grown closer to 35-40 patients per month. We currently have ~850 members.

Here are some things we’ve learned…

  1. We haven’t seen that seniors use membership services more than others - there are ‘heavy’ and ‘light’ users in all age brackets, although appointment frequency drops significantly in the 18-35 year old range.

  2. We hired an RN too early, and basically wasted a $72K salary (I didn’t take a paycheck for much of that time… ouch). Our physician was determined to have help as he did in the other system, but realized he didn’t need it - and still doesn’t with ~850 members promising same-day appointments.

  3. The ‘sales’ cycle (the time it takes between people first hearing about your service and actually becoming a member) is much longer than you would hope - especially with employer groups. Interested employer groups can take at least 1 year, up to 3 years to come around, and individuals can take at least a couple months (except when they have recently experienced a pain point that you answer directly).

3.5) As we predicted, we didn’t want to take on a lot of employer groups at first, because we didn’t want to live and die by them (lose 50-100 members of your 400 member practice, and that hurts).

  1. Quickbooks stinks and requires too much maintenance. Use Hint or something built specifically to manage membership billing.

  2. Hiring the right people is absolutely key. Read Geoff Smart & Randy Street’s book “Who” for tips on hiring successfully.

That’s a start… I’ll share more as I think of things…

(Robin Dickinson) #3

This has been my experience as well. I remember @appalenia mentioning to me once that physicians will hire help before they will pay themselves! But I also have not found that I need an RN or MA. My practice is intentionally smaller but I work part time (not “physician part time” of 30-40 hours but truly part time) with my 400 patients and do just fine without any staff. I imagine if I had twice as many patients, I’d just work closer to that 30-40 hours and still not need staff.

So true![quote=“Jason, post:2, topic:749”]
The ‘sales’ cycle (the time it takes between people first hearing about your service and actually becoming a member) is much longer than you would hope

In the past I’ve had individuals come in 1-2 years after first hearing about me! I’ve noticed though that now that DPC is becoming more normal and talked about, people aren’t waiting as long. A lot of people lately have heard DPC exists, search for a DPC near them, and sign up that day. It will be interesting to see what happens going forward.

TOTALLY agree on this one.

I figured that out really fast too! Integrated payment within my EMR has been a key to my own sanity.

@Jason How did you guys grow so quickly initially? Why do you think your growth is picking up again now?

(Jason Larsen) #4

We mailed letters to about 2,500 of his 4,000 patients about the transition to his new practice (we started cold turkey to DPC in a new building and everything). We also started with essentially no commitment from patients (we now have an initial 6 month commitment, after which is month-to-month), which lowered the barriers to joining membership.

If we did it again, we would definitely do some things differently, as we put way too much pressure on that initial letter.

I think for a few reasons…

  1. As the only DPC clinic in our area, more people are talking about us as we keep growing.

  2. The physicians we have hired to cover for us are in love with our model, so when they encounter patients that are frustrated with lack of access, they plug our membership. Not bad when another physician or ARNP recommends they should join someone else for better care!

  3. We’re starting to get some of those employer groups signing up (most of them small - 20 or fewer employees) that we have been ‘dating’ for the past couple years.

  4. Our front office staff (we have 2 full time gals that do a lot of office work, billing, patient communication, medication refilling, and more) are getting better at ‘selling’ our clinic to potential members rather than just offering information.

  5. I’d like to think that our sales funnel is also getting better (I hate the term ‘sales funnel’ because we’re talking about real people here, and caring for them and their families - but I don’t know what else to call it).

(Adrienne Wolf) #5

Hi - I’m new here! Thank you all for sharing your experiences.
I’m wondering how you get in front of small businesses? I’ve not had much luck in this arena and would be interested to know how you guys are doing it.

(Jason Larsen) #6

Hi @adriennewolf! Welcome.

There are a few ways to get in front of small businesses. We’ve done them all - cold calls, cold emails, networking through familiar friends, direct mail advertising, and other marketing / personal outreach methods.

The places where you can start that are “low hanging fruit” is a chamber of commerce business meeting group (normally made up of small businesses where the owners are looking for affordable health options).

You should also consider your current patient panel and have your members reach out to their employer on your behalf. That is sometimes quite effective - especially if you give them your business card or a brochure and let them know you’re willing to meet with their employer.

Another place to look is to think through businesses that will likely “have” to offer a health plan to their employees (because they employ over 50 people), but likely can’t offer a great plan because they have low-wage workers (think nursing homes, adult living facilities, large construction companies, etc.). You can ask the owner or HR folks to meet, and then suggest presenting to all of the employees - letting them know the benefit of your clinic and how you can help ‘keep them away from their deductible’ (especially since your monthly fees are likely lower than their annual high deductibles).

You won’t get all the employees, but they will slowly come to you year after year, after hearing experiences from their peers. AND, it’s going to be a great option for their families, too. You may luck out and find an employer that wants to contribute part of your membership to their employees (we’ve had a few businesses end up doing this after a couple years of hearing their employee’s experiences with us).

The bottom line is that it takes a lot of work to get in front of businesses. We’ve had good success because I am not a physician, but am in charge of the business aspects, so I have time to go and talk with businesses - as I’m not seeing patients. Dr. Edgerly (our lead physician) came along at first, but hasn’t been to many meetings unless they are larger employers where we’re presenting to many employees.

Speaking of other people doing outreach for you - you could also reach out to local insurance brokers / benefits advisors to see if they would be interested in talking to their clients about your service. Be careful, though - many of them will think that you’re competing with their business (you’re mainly helping theirs, and offering their clients an excellent service). And also be careful about signing any exclusive agreements - those can lock you in a little too much if it’s the wrong place.

I hope that helps!

(Adrienne Wolf) #7

oops - sorry

(Jason Larsen) #8

Hi @adriennewolf! Glad I could help a bit.

First, I’ll answer your questions…

  1. We are members of our Chamber of Commerce and a Building Association (mostly contractors and construction companies, but we see value in connecting with them and offering them value when possible). We’re not very active anymore, but mostly that’s my personality - I’m not a big ‘salesman’ or networker at heart. There could be an advantage to being active in those groups, I believe.

  2. When we cold call (we don’t much anymore, but occasionally), we would usually ask for the person that makes decision on healthcare benefits. But, most often we would try to find out who that person was before we even called, so we could ask for them by name.

  3. Direct Mail - we haven’t done many direct mail campaigns, but I’ll let you know when we do! The only one we’ve done was a blanket “EDDM - Every Door Direct Mail” through the USPS where we chose the neighborhoods and invited people to a seminar (both businesses and residences). It paid for itself, but just barely.

As for your email, I would honestly shorten it quite a bit and try to personalize it to each person… and follow up each email either 2-3 times (or even better, with a phone call), as often they’ll get back to you after they see you’re reaching out to them - not a mailing list.

Example email…

Hi John,

My name is Dr. NAME, and I’m a physician in the area.

I have just began offering membership-based primary care services for people in CITY, and so far it has saved families and businesses hundreds - even thousands of dollars - on health care costs. Membership starts at just $49/monthly and includes same-day / unlimited appointments, 24/7 phone access and more…

I’m wondering if we can meet to talk more about how our plan could benefit your employees - just for 15 minutes or so?

If you’re looking for a reference, feel free to talk with NAME over at BUSINESS NAME - they would be able to talk about how we’ve helped them recently.

Thanks, NAME. I’ll be calling in a couple days to follow up,


If you wanted a free way to keep track of everybody you’re emailing and/or calling - use either an Excel Spreadsheet or Trello (

An even better solution is using - which is a monthly fee, but built for sales like this - where you’re contacting people and forced to follow up with them. We use it and it’s great - it helps keep us organized.

I hope that helps!

(Adrienne Wolf) #9

Hi Jason,
Thank you again for your excellent response and information. I really appreciate it! This has helped me tremendously! I’ll keep you posted on how it all goes.
Thanks again!

(Jason Larsen) #10

@adriennewolf - I’d love to hear how everything goes!

Glad to help, and best of luck to you!